Comparison of Three-Level Triage Versus Five-Level Emergency Severity Index for Prediction of Hospital Outcome of Emergency Patient

PURPOSE: This study compared the performance for the prediction of three-level versus five level triage tool (Emergency Severity Index version 4, ESI) on the hospital outcome of emergency patients. METHODS: This was an observational study that included all patients >15-year-of-age visiting an urban tertiary hospital emergency department (ED) in Korea from July 2007 to December 2008. We collected data from the electronic medical records, which included demographic factors, hospital outcome including admission to intensive care unit (ICU) and hospital mortality, and result of triage at arrival to ED. A three-level triage tool was used in the first year (July 2007 to June 2008), divided in four 3-month periods (threelevel phase). For 5 weeks, the three-level tool and ESI were used simultaneously (test phase). For the last 4 months, ESI was used for triage (five-level phase). We described the demographic findings of each study phase and compared the performance for the prediction of admission to ICU as well as hospital mortality, using the area under the receiver operating characteristic curve (AUC). RESULTS: A total of 34,342 patients during three-level phase, 3,371 during the test phase, and 11,048 during five-level phase were involved. Demographic findings about gender, age, week and time of visiting to ED, use of ambulance service, injury or illness, and results after ED management were similar without significant difference. Proportion of admission to ICU and hospital mortality at ED and on the ward was 6.1% in period 1, 6.1% in period 2, and 5.6% in period 3 of the three-level phase, 5.8% in the test phase, and 5.8% in the five-level phase. The calculated AUC of the three periods in the three-level phase was 0.747 (95% Confidence Interval, CI, 0.729~0.765), 0.786 (95% CI, 0.769~0.804), and 0.786 (95% CI, 0.769~0.804). During the test phase, the AUC of the three-level was 0.820 (95% CI, 0.786~0.854) and that of the five-level was 0.842 (95% CI, 0.809~0.874). During five-level phase using ESI, AUC of ESI was 0.826 (95% CI, 0.809~0.844). CONCLUSION: ESI showed greater ability to predict hospital mortality than the three-level triage tool of emergency patients in a Korean ED, where the emergency care system and insurance coverage differs from North America.

Epidemiology of Patients Using the Resuscitation Room in an Emergency Department

PURPOSE: The resuscitation room is the hub of intensive care and focused management within the emergency department (ED). For patients with life-threatening conditions, immediate triage and proper treatment using the resuscitation room is important. This study was conducted to assess the epidemiology of patients using the resuscitation room in an emergency department. METHODS:This was a retrospective observational study. Eligible subjects were enrolled through the National Emergency Department Information System from July 2007 to September 2008. All subjects came through a single regional emergency center that logs more than 45,000 patients annually. Pediatric patients less than 15 years of age and those who were dead on arrival at the ED were excluded. The Emergency Severity Index (ESI) version IV was used as a triage tool, and characteristics and ESI levels of patients using or not using resuscitation rooms were compared. RESULTS: The total number of eligible subjects was 40,926 and the male-female ratio was 1:0.92. The numbers of patients using the resuscitation room was 1,050 (2.99%). Patients using the resuscitation room were older than the patients not using the resuscitation room, were more likely to have used an ambulance to visit the ED, and had a higher mortality rate and a higher admission rate. A majority of staff members had the authority to put patients in the resuscitation room. Among them were professors 18.19%, emergency residents 11.43%, certified emergency nurses 40.57%, emergency nurses 19.43%, emergency medical technicians 2.86%, and paramedics 6.19%. Critical care was done in the resuscitation room for cardiopulmonary resuscitation 11.66%, intubation 26.33%, ventilation 1.71%, defibrillation 5.73%, and other 54.57%. The most frequent ESI levels of patients using the resuscitation room was 1 (57.89%); an ESI score of 3 (72.01%) was the most frequent value for patients not using the resuscitation room. CONCLUSION: Patient using the resuscitation room were older, more likely to have used an ambulance, and had a higher mortality rate, admission rate and ESI level.

Evaluation of the DINAMAP 8100 Automated Blood Pressure monitor: comparison with the Mercury Sphygmomanometer / 기본간호학회지

Automated blood pressure monitors have gained acceptance in many clinical settings with the increasing demand, the accurate BP measuring devices require the need for validation. We have evaluated the Dinamap 8100, an oscillometric automated blood pressure monitor, using the Mercury sphygmomanometer as a reference. Comparison of sphygmomanometers was conducted 60 patients(30-Normotensive group, 30-Hypertensive group at Seoul National University Hospital. Two trained observers took measure blood pressure(systolic/diastolic) at the same time using the Dinamap 8100 on one arm and the Mercury on the other. For each measurement, the device was randomly selected from a group of devices repletively used for the experiment. Mean readings for systolic pressure with the Dinamap 8100 in normotensive group were lower(mean difference ; 4.26mmHg) than the Mercury type. Mean readings for systolic pressure with the Dinamap 8100 in hypertensive group were lower(mean difference ; 9.05mmHg) than the Mercury type. Mean readings for diastolic pressure with the Dinamap 8100 in normotensive group were lower(mean difference ; 7.46mmHg) than the Mercury type. Mean readings for diastolic pressure with the Dinamap 8100 in hypertensive group were lower(mean difference ; 9.03mmHg) than the Mercury type. We have found that blood pressure readings with the Dinamap 8100 were lower than those with the Mercury type. we are using the Mercury type in clinics, although it has observer bias and terminal digit preference. But the Dinamap 8100 is readily portable, simple to use, and capable of preventing observer bias and terminal digit preference. The Dinamap 8100 is acceptable for blood pressure determination in subjects who are normotensive or hypertensive ones.